Acute Pneumothorax Evaluation and Treatment

Karima R. Sajadi-Ernazarova, Jennifer Martin, Nagendra Gupta

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.

Pneumothorax - is an accumulation of air or gas in the pleural space (the space between visceral and parietal pleura of the chest cavity), which can impair with ventilation, oxygenation, or both. This condition can vary in its presentation from asymptomatic to life-threatening.

Pneumothorax can subdivide into three broad categories according to the etiology:

1. Traumatic - resulting from blunt or penetrating chest trauma. Majority of all pneumothoraces are traumatic in origin
2. Iatrogenic - caused by manipulation by a healthcare provider, such as the insertion of central lines, etc
3. Spontaneous - a pneumothorax without any apparent cause or inciting event.

Pneumothorax can also be classified based on their physiology into the following types:

1. Simple - when the air in the pleural space does not communicate with an outside atmosphere, and there is no shift in mediastinum or hemidiaphragm. An example is a pleural laceration from a fractured rib.
2. Communicating - when there is a defect in a chest wall, such as from a gunshot wound, that causes open communication with an outside atmosphere. This loss of the chest wall integrity can create an air sucking and a paradoxical lung collapse, thus causing significant ventilatory problems.
3. Tension - progressive accumulation of air in the pleural cavity causing the shift of mediastinum to the opposite side, resulting in compression of vena cava and other great vessels, decreased diastolic filling, and ultimately compromised cardiac output. It occurs when a chest injury causes a one-valve situation when the air gets into the pleural cavity but is unable to escape freely and thus gets trapped.